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Community Diagnosis

Presented by: Menuka Shrestha M. Sc Nursing , Batch 2011


Introduction Definition Goal Importance of community diagnosis Contents of community diagnosis Process of community diagnosis Comparision patient diagnosis and community diagnosis
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A community is a cluster of people with at least one common characteristic (geographic location, occupation, ethnicity, housing condition, etc.).

A group of people with a common characteristic or interest living together within a larger society comprises a community.



Community diagnosis is a comprehensive assessment of health status of the community in relation to its social, physical and biological environment. The purpose of community diagnosis is to define existing problems, determine available resources and set priorities for planning, implementing and evaluating health action, by and for the community.



Community diagnosis generally refers to the identification and quantification of health problems in a community as a whole in terms of mortality and morbidity rates and ratios, and identification of their correlates for the purpose of defining those at risk or those in need of health care.


History of community diagnosis

The concept of diagnosis has evolved since second world war. Two major disciplines of health that are public health and nursing are background for the development of commu nity health diagnosis approach. It is originally used by physicians in 1950s. The current approach of community diagnosis originally derieved from the work of Freeman in 1970 & Hogue in 1977.



it is a quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement and stimulates action. - WHO



Analyze the health status of the community

Evaluate the health resources, services, and systems of care within the community
Assess attitudes toward community health services and issues Identify priorities, establish goals, and determine courses of action to improve the health status of the community Establish an epidemiologic improvement over time. baseline for measuring


Importance of Community Diagnosis

It helps to find the common problems or diseases, which are troublesome to the people and are easily preventable in the community.
Community diagnosis can be a pioneer step for betterment of rural community health. It is a tool to disclose the hidden problems that are not visible to the community people but are being affected by them.
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It helps to access the group of underprivileged people who are unable to use the available facilities due to poverty, prevailing discriminations or other reasons.

It helps to find the real problems of the community people which might not have perceived by them as problems.
It helps to impart knowledge and attitudes to turnover peoples problems towards the light of solution.
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Content of community diagnosis

A program coordinator should know the following facts about the community: 1. Hard measurable facts age sex distribution literacy status Prevalence of disease Land holdings Irrigation facilities Sanitary condition others
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2. Aspects that cant be measured (soft facts): customs Beliefs Taboos Attitudes Values towards various situations.



3. Overall organizational pattern of the community within which there are several sub organization.

E.g. castes with their own values and pattern of conduct. Each sub organization is intricately interrelated to the other and to the overall community, thereby affecting its entire behaviour,




The process of community diagnosis is a continuous learning experience both for the program coordinator and the community. When considered in all its aspects community diagnosis may seem an unassailable task, yet it is a simple process that develops gradually and only requires keen perceptiveness, observation, and the study of the facts obtained.



Process of Community Diagnosis

How is the community diagnosed?




The process of community diagnosis involves four stages: 1. Initiation

2. Data collection and analysis

3. Diagnosis 4. Dissemination
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1. Initiation

A dedicated committee or working group should be set up to manage and coordinate the project. The committee should involve government departments, health professionals and nongovernmental organizations. At an early stage, it is important to identify the available budget and resources to determine the scope of the diagnosis.
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Some of the common areas to be studied include health status, lifestyles, living conditions, socioeconomic conditions, physical and social infrastructure, inequalities, as well as public health services and policies. Once the scope is defined, a working schedule to conduct the community diagnosis, production and dissemination of report should be set.



2. Data collection and analysis

Population Census and statistical data as for the community data, it can be collected by conducting surveys through self-administered questionnaires, face to face interviews, focus groups and telephone interviews.




Community analysis is the process of examining data to define

Needs Strengths Barriers Opportunities Readiness Resources

The product of analysis is the community profile.

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To analyze assessment data is helpful to categorize the data. This may be done as follows:

Demographic Socioeconomic Environmental Health resources and services Health policies Study of target groups

Collected data can then be analysed and interpreted by experts.

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3. Diagnosis

Diagnosis of the community is reached from conclusions drawn from the data analysis. It should preferably comprise three areas:

Health status of the community Determinants of health in the community Potential for healthy city development.



Community is diagnosed using

Health indicators

Indicators of health are variables used for the assessment of community health.



Characteristics of health indicators

should be valid, i.e., they should actually measure what they are supposed to measure;
should be reliable and objective, i.e., the answers should be the same if measured by different people in similar circumstances; should be sensitive, i.e., they should be sensitive to changes in the situation concerned,




should be specific, i.e., they should reflect changes only in the situation concerned, should be feasible, i.e., they should have the ability to obtain data needed, and; should be relevant, i.e., they should contribute to the understanding of the phenomenon of interest.



Classification of health indicators

Mortality indicators Morbidity indicators Disability rates Nutritional status indicators Health care delivery indicators Utilization rates




Indicators of social and mental health Environmental indicators Socio-economic indicators Health policy indicators Indicators of quality of life Other indicators



Mortality Indicators

Mortality Rates Crude death rates Specific death rates: age/disease Expectation of life Infant mortality rate Maternal mortality rate Proportionate mortality ratio Case Fatality rate



Morbidity Indicators

Morbidity rates
Data on morbidity are preferable, although often difficult to obtain.

Incidence and prevalence Notification rates Attendance rates: outpatient clinics or health centers. Admission and discharge rates Hospital stay duration rates


Disability Indicators

Disability rates

No. of days of restricted activity

Bed disability days Work/School loss days within a specified period. Expectation of life free of disability
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Nutritional Indicators

Nutritional Status Indicators

Anthropometrics measurements
Height of children at school entry Prevalence of low birth weight Clinical surveys: Anemia, Hypothyroidism, Nightblindness
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- It is an indicator of positive health

Health Care Delivery Indicators

Health Care Delivery Indicators

- Reflect the Equity / Provision of health care

Doctor / Population ratio

Doctor / Nurse ratio Population / Bed ratio Population / per health center



Utilization Indicators

Health care utilization Rates

- Extent of use of health

services - Proportion of people in need of service who actually receive it in a given period

Proportion of infants who are fully immunized in the 1st year of life. i.e..immunization coverage. Proportion of pregnant women who receive ANC. Hospital-Beds occupancy rate. Hospital-Beds turn-over ratio



Social/Mental Health Indicators

Indicators of Social and Mental Health

- Valid positive indicators does not often exist - Indirect measures are commonly used

Suicide & Homicide rates Road traffic accidents Alcohol and drug abuse.



Environmental Indicators

Environmental health Indicators

- Reflect the quality of environment

Measures of Pollution
The proportion of people having access to safe water and sanitation facilities Vectors density



Socio-economic Indicators

Socio-economic Indicators
health status.

Rate of population increase Per capita GNP Level of unemployment Literacy rates - females Family size Housing condition e.g. No. of persons per room

- Is not a direct measure of

- For interpretation of health care indicators.


Health Policy Indicators

Health Policy Indicators - Allocation of adequate


Proportion of GNP spent on health services.

Proportion of GNP spent on health related activities.

Proportion of total health resources devoted to primary health care



Other Indicators

Other health indicators

Indicators of quality of life. Basic needs indicators. Millennium goal indicators



4. Dissemination

The report can be disseminated through the

Presentations at meetings of the health boards and committees, or forums organized for voluntary organisations, local community

groups and the general public Press release Thematic events (such as health fairs and other health promotion programmes).



Flowchart describing the community diagnosis process



Comparing patient diagnosis & community diagnosis

There are a number of SIMILARITIES between patient diagnosis and community diagnosis. These are listed below :-



Patient Diagnosis
1) Obtain a history of the patient symptoms
2) Examine the patient & look for signs 3) Perform laboratory testes X ray & other investigations 4) To infer causation from the history make diagnosis. 5) Provide Treatment

Community Diagnosis
1) Obtain information about the community meetings & discussions
2)Obtain hard measurable fact 3)Conduct specific surveys based on findings of basic demographic survey 4)Make inference from the data to make the community through basic demographic survey. 5)Prescribe community health action as part of a community health programme 6) Evaluation the effect of community health action .
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6) Follow up & assess the effectiveness of the treatment .

Patient Diagnosis
1. Patient aware of their problems 2. Takes initiative for problems 3. Clinicians usually examines pt. after dz. has started. 4. Submit to remedial measures

Community Diagnosis
1. Community may or may not be aware of the problems 2. Community rarely takes collectively initiative of seeks advice 3. Attempts are made to understand why the dz. exists & how can be prevented. 4. Remedial measures cannot be prescribed or imposed on a community

5. Pathological condition affects 5. Cannot be treated as isolated occurrences. patient alone. It is often unrelated Each condition is linked to other to environment interrelated factors in the environment
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World Health Organization. City Health Profiles: how to report on health in your city. ICP/HSIT/94/01 PB 02. Available at: Garcia P, McCarthy M. Measuring Health: A Step in the Development of City Health Profiles. EUR/ICP/HCIT 94 01/PB03. Available at: